The importance of sustained blood pressure control

The case for antihypertensive drug regimens that produce consistent 24-h bl ood pressure control has largely been founded upon a series of epidemiologi cal observations that were either cross-sectional or alternatively relative ly small-scale followup studies. More recent data have unequivocally demons trated, in a prospective study in hypertensive subjects with left ventricul ar hypertrophy, that the reduction in left ventricular mass index during th e course of one year's antihypertensive treatment, was predicted much more closely by treatment-induced changes in ambulatory blood pressure than by c hanges in clinic blood pressure. This provides definitive and confirmatory data to support the aim of achieving blood pressure control, which is based upon a smooth and consistent antihypertensive effect over a full 24-h dosa ge interval. Regimens which provide such control may also offer the advanta ge of a sustained duration of effect beyond 24 h. This characteristic is at tractive because even the most compliant patient may inadvertently miss at least one dose of medication each week. Evidence from a number of studies w hich have sought to mimic this pattern of suboptimal compliance by delibera tely inserting a placebo phase into a steady-state treatment regimen, has c learly demonstrated the benefits of antihypertensive drugs with intrinsical ly long duration of action. Furthermore, there is evidence to suggest that following cessation of therapy there is a biphasic reversion of blood press ure towards baseline levels with a maintenance of a residual effect which i s more pronounced with a long-acting agent when compared to a shorter-actin g dug from the same therapeutic class. There is increasing evidence, albeit not derived from prospective outcome studies, that indicates that the bene fits of antihypertensive therapy are likely to be maximized by treatment re gimens which result in sustained blood pressure control.